Recent guidelines from the American Heart Association and American Stroke Association reviewed antithrombotic therapy options for secondary prevention of stroke in patients who have had a stroke or transient ischemic attack (TIA).

Arterial thrombi are composed mainly of platelet aggregates held together by small amounts of fibrin. Antiplatelet drugs are the drugs of choice for prevention and treatment of arterial thrombosis, but anticoagulants are also effective, and their effects can add to those of antiplatelet drugs. Venous thrombi are composed mainly of fibrin and trapped red blood cells, with relatively few platelets. Anticoagulants are the agents of choice for prevention and treatment of venous thromboembolism and for prevention of cardioembolic events in patients with atrial fibrillation.

Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) are common causes of peptic ulcer disease. Patients infected with Helicobacter pylori who take aspirin or another NSAID have an especially high risk. Drugs that have been tried for prevention of ulcers in patients taking NSAIDs including H₂-receptor antagonists, proton pump inhibitors (PPIs), aluminum- or magnesium-containing antacids, the prostaglandin misoprostol (Cytotec, and others), and antibiotics to eradicate H. pylori.

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Arterial and venous thrombosis are major causes of morbidity and mortality. Arterial thrombi consist of platelet aggregates held together by small amounts of fibrin. Antiplatelet drugs are the drugs of choice for prevention and treatment of arterial thrombosis, but anticoagulants are also effective, and their effects can add to those of antiplatelet drugs. Venous thrombi are composed mainly of fibrin and trapped red blood cells, with relatively few platelets. Anticoagulants are the agents of choice for prevention and treatment of venous thromboembolism and for prevention of cardioembolic events in patients with atrial fibrillation.

Aggrenox, a fixed-dose oral combination of aspirin and extended-release dipyridamole, is now being advertised for secondary prevention of a transient ischemic attack (TIA) or ischemic stroke.

Myocardial perfusion imaging and stress echocardiography in patients who cannot exercise may require use of drugs. Arbutamine (GenESA - Gensia Automedics), a potent synthetic sympathomimetic, has recently been approved by the FDA for use with a computerized drug-delivery system in pharmacologic stress testing.

Myocardial images produced by injections of radioactive thallium chloride (201Tl), usually during exercise, have been used for many years for diagnosis of coronary artery disease (Medical Letter, 21:49, 1979). Recently, some new techniques and radiopharmaceuticals have become available for myocardial imaging.

Adenosine (Adenocard - Fujisawa), an endogenous purine nucleoside, was recently approved by the US Food and Drug Administration for intravenous treatment of paroxysmal supraventricular tachycardia, including Wolff-Parkinson-White (WPW) syndrome. Adenosine is not approved for and has not been effective in treating atrial flutter, atrial fibrillation, or ventricular tachycardias.

Taking aspirin to prevent recurrence or worsening of cardiovascular disease has become a common practice in recent years (Medical Letter, 28:31, 1986). Now, the US Food and Drug Administration is considering whether aspirin can also be advertised for prevention of a first myocardial infarction in previously healthy people.